At least 16 million Americans have chronic asthma, chronic bronchitis or emphysema alone or in combination and this disease spectrum is commonly labeled COPD. The symptoms that accompany COPD are cough, expectoration, wheeze, and dyspnea, with varying degrees of severity. Cough and expectoration signify mucus in conducting air passages. Dyspnea is the symptomatic counterpart of increased work of breathing because of increased airflow resistance from airways obstructions and reduced elastic recoil of the lungs. Objective increases of airflow obstruction (limitation) and forced vital capacity are used to assess disease severity, responses to therapy, and prognosis; however, patients seek relief of symptoms when they consult their physician and the objective evaluation of these symptoms can establish treatment goals for therapeutic interventions.
Patient management should be viewed with enthusiasm since there is much that can be done. Whether the patient is mildly, moderately, or severely symptomatic, therapeutic interventions and supportive measures should be tailored to prevent, reverse, or manage this disease, and achieve functional improvement and enhance the patients well-being. It is important to emphasize the advantages of early diagnosis and individualized treatment, taking into consideration the pathophysiology, symptoms, and quality of life of these patients. cialis soft tablets
This randomized, double-blind, placebo-controlled study compared the clinical effects of iodinated glycerol and placebo in 361 patients with moderately advanced airflow obstruction in patients with chronic bronchitis. The study was done in the offices of sub- specialists (pulmonologists/allergist). The randomization procedure yielded two similar groups. The overall baseline FEVi levels were indicative of significant obstructive lung disease (mean baseline FEVi of 43-45 percent) with patients demonstrating a less than 5 percent response to bronchodilator challenge.
Four specific symptoms and four global parameters comprised the primary analyses of efficacy as defined by the protocol. Of these primary efficacy parameters, cough frequency, cough severity, and chest discomfort were significantly improved by iodinated glycerol as compared with placebo in the intention-to-treat analysis (p<0.05). Dyspnea showed a trend toward improvement in the intention-to-treat analysis and improved significantly in the moderately-to-severely affected subgroup of patients (p<0.02). The patients’ ease in bringing up sputum and the patients’ global assessment also were and significantly improved by iodinated glycerol as compared with placebo (p<0.02). At the same time, the physicians’ evaluations did not demonstrate any improvement. Similar findings were noted in the analyses of more severely ill patients based upon their symptom scores as baseline. Six secondary efficacy parameters were also assessed in the study and three (duration of acute exacerbations, incidence of adverse drug reactions, and incidence of dropouts) of the six demonstrated an improvement that favored treatment with iodinated glycerol, while the other three (frequency of aerosol bronchodilator use, frequency of concomitant medication use, and incidence of acute exacerbations) favored neither group.
Although the importance of mucus in the manifestation of COPD long has been acknowledged, therapy was primarily focused on managing other reversible components. Mucus has been relegated to a lesser treatment goal partly because of a failure to adequately appreciate the potential role of mucolytic-expectorant therapy in management and also because of the lack of well-controlled efficacy studies. Further, as pointed out by King, the study of mucus-airflow interactions has been largely neglected despite its importance from the standpoint of mucus clearance. However, it is noteworthy that previous studies have shown that reduction of symptoms (cough frequency and cough severity) usually accompanies a week or more of mucolytic-expectorant therapy. Viagra Super Active
Cough is an essential mechanism for mucus clearance in chronic bronchitis, but severe chronic non- productived cough can result in fatigue or exhaustion and can worsen the patients condition. Therefore, a reduction in cough frequency and severity is clinically important because the progression of disability in COPD patients tend to slow down when coughing either disappears or is controlled.